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Child Psychiatrist /Adult Psychiatrist

MDMA Enhances PTSD Therapy Efficacy by Improving Self-Experience Processes

MDMA-assisted therapy for PTSD led to significant self-experience improvements, even after controlling for CAPS-5 score changes.


In study findings published in PLOS One, 3,4-methylene-dioxymethamphetamine (MDMA)-assisted therapy for post-traumatic stress disorder (PTSD) had a positive effect on transdiagnostic mental processes of self-experience. Given that these processes are often associated with poor treatment outcomes, psychedelic agents that target these psychological capacities could lead to major improvements in PTSD symptomatology.

Based on its positive performance with significant and sustained reductions in PTSD symptoms and acceptable safety profiles, the Food and Drug Administration (FDA) has designated MDMA-assisted therapy as a breakthrough therapy for PTSD. Studies involving healthy volunteers have demonstrated a positive effect of MDMA on self-regulatory capacities and self-compassion. Therefore, researchers assessed exploratory data from a randomized, double-blind, placebo-controlled study comparing the safety and efficacy of MDMA-assisted therapy to therapy with placebo among participants with severe PTSD. Treatment effects for self-experience were compared across scales of alexithymia, self-compassion, and an inventory of altered self-capacities.



PTSD


The study sample consisted of 90 participants with severe PTSD, as confirmed via the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria and the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Among the participants, 64.4% were women, 80.3% were White, and 92.7% were non-Hispanic or Latino. All participants underwent 3 preparation therapy sessions prior to experimental assignments, which consisted of 3 separate 8-hour experimental sessions, spaced about 4 weeks apart, of either MDMA-assisted therapy or therapy with placebo. The dosage was 80 mg + 40 mg MDMA HCl for the first experimental session and increased to 120 mg + 60 mg MDMA HCl in the second and third sessions.


Relative to therapy with placebo, the group receiving MDMA-assisted therapy showed significantly greater improvements in all self-experience measures, except for the altered self-capacity factor of identity diffusion (P =.08). The MDMA-assisted therapy resulted in greater improvements in alexithymia (P =.0002), self-compassion (P <.0001), and most altered self-capacity factors, compared to placebo. However, upon adjusting for changes in CAPS-5 scores, only the improvements in self-compassion remained statistically significant (unadjusted for CAPS-5 change, P <.0001; adjusted for CAPS-5 change, P =.0076).


In addition to the main treatment effects, the researchers evaluated interactions between treatment groups and the baseline categories. Participants with greater baseline alexithymia experienced a greater reduction in CAPS-5 scores in the MDMA-assisted therapy group, with a decrease of 16.16 (95% CI, -28.80 to -7.52). Additionally, when compared to individuals in the placebo group who had high baseline alexithymia, there were significantly greater improvements in CAPS-5 scores for participants in the MDMA-assisted therapy group with both low (P =.02) and high (P <.0001) baseline alexithymia.


These findings indicate that MDMA has a significant impact on the regulation of emotions and self-experience measures, particularly alexithymia and self-compassion. Study authors concluded, “MDMA may be particularly effective for enhancing treatment efficacy by improving a range of problems with self-experience that are associated with treatment resistance.”


The study results may be limited by a lack of information on outcomes of trust and intimacy, an inability to control for age and type of trauma exposure, and the homogenous demographics that may not reflect an epidemiologically representative PTSD population.


This article originally appeared on Psychiatry Advisor

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